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HomeMy Public PortalAbout5241 SANTA ANITA AVE_Plumbing__ 76A667-CE*817 10-67 I, _ 1.lL, - o v -. APPLICATION FOR PLUMBING PERMIT COUNTY,OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION4LocALiTy BUILDING JOHN.A. LAMBIE. COUNTY ENGINEERADDRESS Double Drive COLEMAN W. JENKINS. SuP'T. OF BUILDING Temple City FOR APPLICANT TO FILL IN(PRNT OR TYPENEAREST NUMBER FIXTURE OR ITEM EACH FEE CROSS ST. " WATER CLOSET 1.50 OWNER Ida L. d• rson BATH TUB 1.50 4ALAaDREss 4].. Double Drive SHOWER. 1:50 CITYcityTEL. 90. 44843SL LAVATORY 1.50 CONTRACTOR SINK 1.50 1 50 ADDRESS DISHWASHER 1.50 CITY TEL.NO. CLOTHES WASHER 1.50STATE LIC LICENSE NO. CLASS _ SWIMMING POOL RECEPTOR 1.50 DISTRICT NO. GROUP ZONE PROCESSED RX- LAWN SPRINKLER SYSTEM 2.00 n- I _ a WATER HEATER 1.50 INDUSTRIAL O WASTE APPROVAL _ O GAS SYSTEM OUTLETS 1.50 INSPECTION RECORD C~.7 OUTLETS OVER 30 d 5 PER SYSTEM y Z Plan check fee 25% of above. See reverse. PLUMBING PERMIT ISSUING FEE $ 2 00 TOTAL FEE 3 50 APPROVALS DATE INSPECTOR'S SIGNATURE, Plan check applicant UNDER SLAB WORK Name IL ROUGH PLUMBING Address ve GAS PIPING GAS VENT City. Tel.-No, HOT WATER HEATER I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY PLUMBING FIXTURES WITH ALL, COUNTY ORDINANCES AND STATE LAWS REGULATING GAS TEST PLUMBING. RED ANDoeft UTILITY CO.NOTIFIED F T 1T LEGAL W E 2NTEND TO RESIDE I R E E81 PRO FINAL. l SIGNATURE JACK.R. ALLEN, SUPERVISING MECHANICAL ENG'R. OF PERMITT �� PERMIT VALIDATION CK.J M.O. CASH PLAN CHECK VALIDATION CK.. M.O. CASH LAGa.5 1.9 4%08 JA2.5, 5 D 3.5-0.. �. D.B.B.17 85M HETB 7-47 APPLICATION PP IC.TI®N FOR MOW DEPA$�TMENT OF BUILDING AND-SAFETY i9�SII�dVt� 166i9IIdi "VOUNTY OF LOS ANGELES L %W.J.FOX.CHIEF ENGINEER NATURE OF INS ALLATION 51srRl 0105o E P nne` �oJ. ROUGH FIXTURES. _COMPLETE �^ 7mr I-I REC 1 BY READY FOR DATE 188UED HEATER CESSPOOL SEPTIC TANK FIRST INSPECTION _ AS. MISCELLANEOUS _ l _ �APPLICANT�,FILL IN HEAVILY OUTLINED PORTION ONLY Joe to NAM7 �l/�, vJCf� / /'�J DDRESS 3,1,6 3 ®� , /�, ADDRESSSi (Q� ld�sem_ [J� �/k.�lp���N�q LOCALITY NEAREST / / `G'"`�x / CITY VL "�/6�i�Q TELW- Of/l 6 'Uhl/ ROSS ST. / !`�� O d� L,tIZ' �V 4Z./ ' COUNTY �`a^ 1 CERT.No. S 7� p Z RXPIRES�..J�1/19 `'1 ` NAME fL 71. LOCATION OF SEPTIC TANS, OR CESSWOL Y MAIL U ... 3 ADDRESS. �S/ �. 0/f 400%e NORTH � O f CITY C TEL.NO. I AM THE LEGAL POSSESSOR OF THE ABOVE LOS .'ANGELES COUN ERTII CF QUALIF C TII JON. A �.. PLUJJ' I AM THE LEGAL OWNER OF TH PROPERTY DESCRIBED ABOVE. . m M 3 - OWNER CORRECTIONS SOUTH .l DESCRIPTION OF WORN z Z BATH TUB FURNACE 0 NOW ER DISHWASHER O r AVATORY REFRIGERATOR --/-- KITCHEN SINK WATER SOFTENER FLOOR SINK SAND TRAP SLOP SINK wOCR DRAIN WASH TRAY' URINAL APPROVALS— WATERk—C WATER CLOSET DRINKINGYCUNTAIN • DATE INOPMCTOR'S NA WATER HEATER DENTAL LAVATORY � eea�r� ROUGH PLUMBING .-M METER—L12—GAS SODA FOUNTAIN GAS PIPING OUTL GAS VENT CESSPOOL TOTAL NUMBER OF FIXTURES " SEPTIC TANK I I ESSPOOI SEPTIC TANK SEWER ! S �) UTILITY CO.NOTIFIED .� _ TOTAL FEE .7 V`' a. FINAL .- -VJWKERS'COMPENSATION DECLARATION APPLICATION q��®pp ��� �p n'Up/, BIND PERMIT ,ki, f>r7reby, affir{n3hat I have a certificate of consent to self in- 776A6667APW a/87 / S r �'8 9(9 ll—L� ®itl+li ®`lA IEIYi . *,certificate of Workers'Compensation Insurance,or a CE 817(REV.8/86) certifies copy thereof(Sec. 3800, Lab. C.) Policy No. 98944 'Company$gOubl-I-6 I,de n ity (S to ( COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS Certified copy is hereby furnished. Certified co is filed with the count building i FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING copy y g inspection NUMBER FIXTURE OR ITEM ADDRESS 5241 Santa Anita Ave. department. @ FEE LOCALITY Temple City Date 6/99 Applicant r WATER,CLOSET(TOILET) igloo NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' 3 BATH TUB 18 .00 CROSS S7. ' COMPENSATION INSURANCE SHOWER OWNER TSL Construction (This section need not be completed if the work involved by MAIL the permit is for one hundred dollars($100)or less.) 5 LAVATORY 30 00 ADDRESS 1.103 S. San Gabriel Blvd. #E I certify that in the performance of the work for which this per- 1 SINK 6 00 CITY San Gabriel v TEL. N(9_85 2925 mit is issued, I shall not employ any person in any manner so as to become subject to the Workers'Compensation Laws. DISHWASHER 6,00 CONTRACTOR Frank .Marrone & SOns, Inc. Date Applicant 1 CLOTHES WASHER 6,0p NOTICE-TO APPLICANT: If, after making this Certificate of Ex- ADDRESS 9860 Lower Azusa Rd. emption,you should become subject to the Workers'Compen- SWIMMING POOL RECEPTOR sation provisions of the Labor Code,you must forthwith comp- LAWN SPRINKLER SYSTEM. CITY El Monte TEL. NC444-2548 ly with such provisions or this permit shall be deemed revok- STATE LIC. c/36 - ed. 1 WATER HEATER 6.00 LICENSE NO-397884 LICENSED CONTRACTORS DECLARATION. DISTRICT NO. "PROSED BY GAS SYSTEM OUTLETS , I hereby affirm that I am,licensed under provisions of Chapter 1 6 7 50b 9(commencing with Section 7000)of Division 3 of the Business OUTLETS OVER `/ fe a,Professions Code, and my license is in full force and ef- 5 PER SYSTEM FINAL v VALIDATIO a 3 9 7884 DATE License Number Lic. Class C/36 O �/f FIN V Contradtor Tf� Date 12/89 BY 0 O ❑ I am exempt under Sec. W B.BP.C. for this reason ® Z Plan check fee Date: j PLUMBING PERMIT ISSUING FEE$ 10.5 •Signature TOTAL FEE - • SINGLE FAMILY HOME OWNER-BUILDER DECLARATION Plan check applicant I hereby affirm that I am exempt from the Contractor's License Name Law for the following reason (Sectiori 7031.5, Business and - Professions Code): Address . :•):•moi . _ Cit Tel. No. I, as owner of the property, will do the work.and the Y _;� �(:( structure is not intended or offered for sale(Section 7044, , Business and Professions Code). D j, j•(LI',�; CONSTRUCTION LENDING AGENCY I?{'a�. OR = I hereby affirm that there is a construction lending agency for t , , .._ the performance of the work for which this permit is issued `'E'" st l { (Sec. 3097, Civ. C.). Lender's Name Lender's Address - I certify that I have read this application and state that the D rtl+ uj'�08 above information is correct. I agree to comply with all County ordinances and State laws regulating Plumbing,'and hereby authorize representatives of this County to enter upon the above-mentioned property for inspection purposes. �� ��� SEE REVERSE FOR EXPLANATORY LANGUAGE Sig afure Pe ' ee Date 7 01! AVC7RK�ERS'COMPENSATION DECLARATION APPLICATION F®IZ PI��NI�IIVG PERMIT 'tierati��.o irm that I have a certificate of consent to self in 76A666 DPW 4/87 L I `a �. 76A667A ,lull \" ,,are,nA certificate of Workers'Compensation Insurance,or a CE 817(REV.8/86) certified coC� the (Sec. 3800, Lab. C.) Policy No. " 949 �' CompanyRPmihl i c TnnPmniti COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS Certified copy is hereby furnished. ' FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING Certified copy is filed with the county building inspection ADDRESS 5241 Santa Anita Ave department. NUMBER FIXTURE OR ITEM @ FEE c 118.100 LOCALITY Tem le City Date sy R9 Applicant 3 WATER CLOSET(TOILET) 18•0� NEAREST CERTIFICATE OF EXEMPTION FROM ORKERS' BATH TUB CROSS ST. COMPENSATION INSURANCE SHOWER OWNER TSL Construction (This section need not be completed if the work involved by MAIL the permit is for one hundred dollars($100)or less.) 5 LAVATORY 30.00 ADDRESS 1103 S. San Gabriel Blvd'#E I certify that in the performance of the work for which this per- SINK mit is issued, I shall not employ any person in any manner so 1 CITY San Gabriel TEL' "°285-2925 as to become subject to the Workers'Compensation Laws. 1 DISHWASHER 6.00 CONTRACTOR Date Applicant CLOTHES WASHER NOTICE TO APPLICANT: If, after making this Certificate of Ex- ADDRESS 9860 Lower Azusa Rd. emption,you should become subject to the Workers'Compen- SWIMMING POOL RECEPTOR CITY E1 Monte TEL' "°. 444-2548 sation provisions of the Labor Code,you must forthwith comp- LAWN SPRINKLER SYSTEM ly with such provisions or this permit shall be deemed revok- STATE LIC. ed. 1 WATER HEATER 00 LICENSE NO. 3 9] CLASS LICENSED CONTRACTORS DECLARATION DISTRICT NO. PRbCESSED BY I hereby affirm that I am licensed under provisions of Chapter 1 GAS SYSTEM 6 OUTLETS 6.00 O A 9(commencing with Section 7000)of Division 3 of the Business OUTLETS OVER / (f fed Professions Code, and my license is in full force and ef- 5 PER SYSTEM I FINAL VALIDATI a r, C/�6 DATE A License Number Lic. Class V 397884pp FI Cr Contractor j!)T4 �,(, j� Date ro7"a % B O I am exempt under Sec. W a B.BP.C. for this reason Plan check fee Date:- PLUMBING PERMIT ISSUING FEE$ 10.50 Signature TOTAL FEE 108.00 SINGLE FAMILY HOME OWNER-BUILDER DECLARATION Plan check applicant 1 hereby affirm that I am exempt from the Contractor's License Name a Law for the following reason (Section 7031.5, Business and -T Professions Co e): Address r: in t r- j i't'�-1L1 ❑ I, as owner of the property, will do the work and the City Tel. No. •t TT--M-­- structure is not intended or offered for sale(Section 7044, L J.11.-11 —, -�_ Business and Professions Code). © I I)'�;L -1 CONSTRUCTION LENDING AGENCY _.. it 1:11.010 I hereby affirm that there is a construction lending agency fortltl the performance of the work for which this permit is issued (Sec. 3097, Civ. C.). �� Lender's Name '. t r•� t•o fly: Lender's Address A ' I certify that I have read this application and state that the above information is correct. I agree to comply with all County ordinances and State laws regulating Plumbing, and hereby authorize representatives of this County to enter upon the above-mentioned property for inspection purposes. 4SInatur-0 ��� e�ft1 SEE REVERSE FOR EXPLANATORY LANGUAGE fP iftee Date